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How to give intramuscular injections

 

Medicines that you give into a muscle are called intramuscular (IM) injections. These injections (shots) are given into areas of the body called injection sites.

The nurse will show you the following steps and give you time to practice before you give an IM injection to your child.

Wash your hands

Getting ready

  • Wash your hands with soap and water. Dry them well. Or, use an alcohol-based hand sanitizer. See “Do you know… Clean hands.”
  • Clean a workspace with an alcohol prep pad. Throw away the alcohol pad.
  • Gather the supplies and open them onto this workspace.

The supplies you need are:

  • Syringe ( ________ ml size) that contains the medicine to be given
  • Extra needle, ___ gauge (___inch)
  • One 1ml Chloraprep® applicator (chlorhexidine gluconate 2% and isopropyl alcohol 70%)
  • Sterile gauze pad
Twist cap off needle
  • Twist the covered needle off the syringe. Twist the extra covered needle (___ gauge) onto the syringe. Place the syringe on the clean workspace.
  • Choose the injection site. (See “Injection sites” below.)
  • Open the Chloraprep® applicator and remove it from the package. Do not touch the sponge tip.
  • Pinch the wings of the applicator to release the solution. You should hear a pop.

Giving the medicine

  • Press on the skin three times, then clean the area where the needle will be inserted with ChloraPrep® using a circular pattern.
  • Clean the skin for 30 seconds, and then let the skin dry for 30 seconds. Do not blot or wipe. Do not blow on the cleaned skin. Let air dry.
Hold syringe like a dart
  • Pick up the syringe and pull back on the needle’s safety cover toward the syringe. Pull the needle cap straight off the needle (do not twist). Set the cap aside. 
  • Hold the syringe like a dart or pencil.
  • Stretch the skin at the injection site. If your child is thin you may need to pinch the tissue between your thumb and index finger. Be careful not to touch the injection site itself.
  • Hold the syringe between the thumb and first finger of the other hand.
Insert needle
  • Insert the needle at a 90 degree angle (straight up and down) into the clean injection site. Use a quick dart-like motion. The quicker you insert the needle, the less it hurts.
  • Release the skin.
Hold the needle
  • Hold onto the syringe so that it will not move. Gently pull back on the plunger just a little to check for blood in the syringe.
  • If you see blood in the syringe, remove the needle from the skin and throw away the syringe and needle. You will need to start over again.
  • If you do not see blood, gently push on the plunger until all the medicine is injected.
Push the plunger
  • Take the needle and syringe out. Cover the site with gauze.
  • Gently massage the injection site.
  • Do not recap the needle. Instead, use the safety cover right away. Using the same hand that is holding the syringe, place your thumb on the finger pad area of the safety cover. Push the cover forward over the needle until you hear or feel it lock. Place the needle and syringe into a patient sharps container. Dispose of other supplies in the regular trash.
  • Clean your hands again after throwing away used supplies.

Injection sites

It is important to select an injection site that avoids major blood vessels and nerves. Rotating the sites (using a new site each time) can keep the tissue from becoming irritated and scarred. Do not use areas that are bruised, tender, swollen, or scarred from surgeries or injury. The nurse can help you locate the correct sites.

The usual IM injection sites include:

  • Thighs,
  • Upper arms,
  • Buttocks, and
  • Hips.

Thigh site for IM injection

Thigh injection site
  • To find the thigh injection site, you will be making an imaginary box on your upper leg.
  • Find the groin. One (1) hand width below the groin becomes the upper border of the box.
  • Find the top of the knee. One (1) hand width above the top of the knee becomes the lower border of the box.
  • The center of the top of the leg becomes the left border of the box.
  • The center of the outside of the leg becomes the right border of the box.
  • The nurse will help you find the landmarks for making the box.
  • The best areas to use for IM injection are in the middle of the imaginary box. The sites are marked with Xs.
  • You may give up to 2ml of fluid in this site.

Upper arm site for IM injection

Injection site in arm
  • To find the arm injection site, you will form an imaginary box on the upper arm.
  • Find the knobby top of the arm, called the acromion process.
  • The top border of the box is 2 finger widths down from the acromion process.
  • The bottom border is an imaginary line running from the crease in the armpit from front to back.
  • To make the 2 side borders, divide the arm into 3 equal sections from front to back. The injection site is in the center of the middle third.
  • Caution: This is a small injection site. Give only one (1) ml or less of fluid in this site. Use only if other sites cannot be used.

Buttock site for IM injection

Injection site buttocks

Not to be used for children younger than 2 years old

  • Find the trochanter. It is the knobby top portion of the long bone in the upper leg. It is about the size of a golf ball.
  • Find the posterior iliac crest. Many people have a dimple over this bone. The nurse will help you find the bone landmarks.
  • Draw an imaginary line between the two bones.
  • After locating the center of the imaginary line. Find a point one (1) inch toward the head. This is where you will place the needle.
  • You may give up to 3ml of fluid in this site.

Hip site for IM injection

Hip site for injection

Not to be used for children younger than 2 years old

  • Find the trochanter. It is the knobby top portion of the long bone in the upper leg. It is about the size of a golf ball.
  • Find the anterior iliac crest. The nurse will help you find the bone landmarks.
  • Place the palm of your hand over the trocanter. Point your first (index) finger toward the anterior iliac crest. Spread the second (middle) finger toward the back, making a “V”. The thumb should always be pointed toward the front of the leg. Always use the first and second fingers to make the “V”.
  • Give the injection between the knuckles of your first and second fingers.
  • You may give up to 3ml of fluid in this site.

Hints for germ free injections

  • Wash your hands with soap and water or use an alcohol-based hand sanitizer. See “Do you know… Clean hands” for details.
  • Do not use any medicine that has changed color or has flakes or specks in it.
  • If part of the sterile syringe is touched, do not use it. Change the un-sterile part for a sterile part, or start over again.

Questions?

If you have any questions or concerns, please call 901-595-3300 and ask for your child’s primary clinic. If you are calling after hours or on the weekend, ask for the doctor on-call or the nursing coordinator. If you are outside the Memphis area, dial toll-free 1-866-2STJUDE (1-866-278-5833), and press 0 once the call is connected.


 

This document is not intended to take the place of the care and attention of your personal physician or other professional medical services. Our aim is to promote active participation in your care and treatment by providing information and education. Questions about individual health concerns or specific treatment options should be discussed with your physician.

St. Jude complies with health care-related federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATTENTION: If you speak another language, assistance services, free of charge, are available to you. Call 1-866-278-5833 (TTY: 1-901-595-1040).

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-278-5833 (TTY: 1-901-595-1040).

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